Abstract

In recent years the Health Authority has conducted a range of investigations around health inequalities in the resident population of East Kent. Recent public health reports have featured the main findings of these investigations (1,2,3). In 2001 the Inequalities Committee, which has guided much of the work, commissioned the Centre for Health Service Studies to conduct a study which focused on inequalities in the use of secondary health care (hospital) services (4). The purpose of this study has been to look for (a) demonstrable links between any unusual rates of hospital inpatient use, and indicators of socio-economic status, and (b) demonstrable links between any unusual rates of hospital inpatient use, and indicators of geographic dispersion by residence across East Kent. Understanding how such inequalities relate to care access should inform primary and secondary care planning and development. The work was done by investigating variations in the use of specific acute hospital inpatient services through analysis of 'hospital episode statistics' (5) for the period 1999/2000. The report described detailed analyses of episodes of acute hospital use for 11 inpatient diagnoses, 21 elective procedures and 20 cancers. Much of the variation discovered was not statistically significant or did not differ to that expected. Some of the variation could be accounted for by explanations unrelated to access. In some cases however significant variation from the mean was discovered in association with deprivation, (by comparative analysis of hospital experience of subgroups according to DETR Index(6)), and or in association with geographic location of residence, (by comparative analysis of subgroups according to local authority of residence(7)) . This paper highlights those findings where an association with deprivation or residential location has been demonstrated by an unusually high or low rate of hospital use, for a specific medical condition or procedure. The fact that an association is demonstrated does not definitively indicate unequal access or opportunities for care. However the findings do 'flag up' instances where unequal access could be operating and are therefore worthy of further investigation. In some instances specific issues for further investigation are proposed.